Clinical Study
Eye (2009) 23, 1134–1140; doi:10.1038/eye.2008.196; published online 4 July 2008
Impact of direct electronic optometric referral with ocular imaging to a hospital eye service
Competing interests: None
The study was funded by the Electronic Clinical and Communications Implementation project (Scottish government)
J R Cameron1, S Ahmed1, P Curry1, G Forrest1 and R Sanders1
1Department of Ophthalmology, Queen Margaret Hospital, Dunfermline, Fife, UK
Correspondence: JR Cameron, Department of Ophthalmology, Queen Margaret Hospital, Whitefield Road, Dunfermline, Fife, KY12 0SU, UK. Tel: + 44 1383 623 623; Fax: + 44 8701 369 737; E-mail: j.cameron@ nhs.net
Received 30 August 2007; Revised 31 May 2008; Accepted 31 May 2008; Published online 4 July 2008.
Abstract
Aims
A study to assess the feasibility, safety, and clinical effectiveness of electronic referral—with and without images—of patients directly from optometrists in primary care to the hospital eye service (HES) in contrast to the traditional paper-based referral, through the general practitioner (GP).
Methods
Three optometry practices sent consecutive referrals with images through the NHS Net to the HES. The standard General Ophthalmic Service form was electronically redesigned with additional information on patient choice for advice, appointment, or surgery. All paper referrals to the HES from the same three optometry practices before the study period were analysed (control group A) as were all paper referrals from the remaining optometrists in Fife (control group B).
Results
A total of 346 electronic referrals were received over 18 months. 218 (63%) were classified as requiring and 128 (37%) as not requiring a HES appointment. The latter were subsequently examined with unexpected pathology found in three cases (glaucoma, macular pigment epithelial detachment, and possible peripheral retinal tear). In both groups, the major pathologies reported were macular degeneration, cataract, glaucoma, diabetic retinopathy, and abnormal retinal appearances. A total of 17 (15%) patients in group A and 26 (8.4%) patients in group B were classified as not requiring HES appointment. These control groups indicate that approximately 10–15% of paper referrals are not seen in the HES. To summarise, therefore, 63% of people referred by the optometrist directly using electronic referral (with or without images) were given a HES appointment compared to 85% of people referred through the traditional paper method (without images) through their GP.
Conclusion
Electronic referral with images to the HES is safe, speedy, efficient, and clinically accurate given some limitations and avoids unnecessary consultation in 37% of referrals.
Keywords:
eHealth, electronic referral, ocular imaging
